Displaced ankle fractures in the geriatric population: Operative or non-operative treatment

In the current study we retrospectively reviewed the outcome and complications of 118 patients over 70 years of age, with displaced ankle fractures. Six patients had open ankle fractures, all treated with open reduction and internal fixation (ORIF). The complication rate of these patients was very high: two below knee amputations and one death due to sepsis. From the 112 patients with closed ankle fractures included in the study, 72 were treated with ORIF and 40 patients were admitted for manipulation under anaesthetic (MUA) and application of cast. The latter had 27.5% failure rate (patients requiring surgery at a later stage) and a 17.2% re-intervention rate (patients requiring re-manipulation to maintain fracture reduction). We report a 4.1% minor wound complication rate (delayed wound healing) and a similar rate of major wound complication (one below knee amputation and two wounds breakdown) in the group treated operatively. One patient in this group developed a non-union of the fracture, requiring arthrodesis of the ankle. Return to pre-injury mobility level was higher (72% versus 47%, p < 0.005) for the patients treated with ORIF. The results of our study indicate that open reduction and internal fixation of ankle fractures in geriatric patients is efficacious and safe in selected patients and age alone should not dictate the treatment of the ankle fractures in geriatric population.